Parent/nurse-controlled analgesia for children with developmental delay.
BACKGROUND
Children with developmental delay are often unable to verbalize pain or advocate for themselves owing to cognitive, motor, or verbal limitations, which puts them at increased risk for poor pain assessment and management. Although patient-controlled analgesia has been shown to be safe, effective, and superior to intermittent opioid dosing, not all children can operate patient-controlled analgesia independently. Parent/nurse-controlled analgesia (PNCA) may be an option for these children. However, the safety and efficacy of PNCA have not been thoroughly evaluated and many practitioners are reluctant to use it.


OBJECTIVE
The purpose of this study was to evaluate the outcomes associated with PNCA in pediatric patients with identified developmental delay.


METHODS
A retrospective review of treatment with PNCA was conducted from a convenience sample of charts for 71 children with developmental delay. Data were collected for 72 hours or until the PNCA was discontinued, whichever came first.


RESULTS
Mean pain scores were low, as was the amount of opioid required to keep patients comfortable. Side effects, with the exception of oxygen therapy, were similar to previous studies regarding PNCA. Somnolence and respiratory depression leading to the administration of naloxone occurred in 2.8% of patients, and potential causes were identified.


CONCLUSIONS
Pain scores, side effects, and adverse events suggest that PNCA may be an effective method of pain control for children with developmental delay. Diligent monitoring and education are crucial to ensure safety.
Czarnecki
Michelle L
ML
Jane B Pettit Pain and Palliative Care Center, Children's Hospital of Wisconsin, Milwaukee, WI 53201, USA. mczarnecki@chw.org
Ferrise
Antonella S
AS
Jastrowski Mano
Kristen E
KE
Garwood
Molly Murphy
MM
Sharp
Mickel
M
Davies
Hobart
H
Weisman
Steven J
SJ
D000293:Adolescent; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009726:Nurses; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000451:nursing; D010290:Parents; D012189:Retrospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine; D004091:Hydromorphone